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MULTIPLE GESTATION

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  1. incidence of twins is 1/80 and triplets 1/6400
  2. 2/3 of twins are dizygotic (i.e. fraternal)
  3. hereditary factors (on maternal side only) and fertility drugs/procedures affect the dizygotic twins rate only
  4. monozygous twinning occurs at a constant rate worldwide (1/250)
  5. determination of zygosity by number of placentas, thickness of membranes, sex, blood type
Classification of Twin Pregnancies

Monoamnionic Monochorionic (forked Cord)

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Monoamnionic Diamnionic Monochorionic

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Diamnionic Monochorionic

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Diamnionic Dichorionic (fused)

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Diamnionic Monochorionic Dichorionic (separated)

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Monoamnionic Monochorionic (Double Monster, one cord)

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Complications Associated with Multiple Gestation



Maternal
Maternal-Fetal
Fetal
1. hyperemesis gravidarum
2. DM
3. preeclampsia / PIH
4. PPH (uterine atony)
5. placental abruption
6. anemia (increased iron and folate needs) increased physiological stress on all systems
7. increased compressive symptoms
8. C-section
1. increased PROM / PTL
2. polyhydramnios
3. umbilical cord prolapse
4. placenta previa
1. prematurity*
2. IUGR
3. mal presentation
4. congenital anomalies
5. twin-twin transfusion (DA/MC)
6. increased perinatal morbidity and mortality
7. twin interlocking (win A breech, win B vertex)
8. single fetal demise


Management

  1. rest in T3
  2. increased antenatal surveillance
  3. close monitoring for growth (serial ultrasounds)
  4. vaginal examinations in third trimester to check for cervical dilatation
  5. may attempt vaginal delivery if twin A presents as vertex, otherwise C-section
  6. twin B should be delivered within 15-20 minutes after twin A (may be longer if FHR tracing adequate)

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MULTIPLE GESTATION MULTIPLE GESTATION Reviewed by Radiology Madeeasy on January 10, 2011 Rating: 5
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